January 9, 2012

What are the beer goggles of medicine?

As the slang term indicates, the more one drinks in claims of complementary and alternative medical efficacy through the ‘power’ of placebo, the less inhibition and discretion one seems to exercise in critical thinking, making the blurred claims of alternative ‘therapies’ seem all the more attractive.

We describe this power of placebo by a common term: the placebo effect. So let’s take a moment and review what that effect actually is:

changes in how pain or subjective symptoms are perceived, not any physiological change that concretely affects the course of a disease.

Does this mean we can control health outcomes with our minds through belief? No. Placebo effects do not shrink tumors or change the underlying pathophysiology of disease. To be clear, there is no good evidence for any objective responses due to placebo; the placebo effect is the change of a patient’s subjective perception to his or her symptoms. Note the emphasis on perception and not on any change to symptoms themselves. This is the repeated mistake people make about understanding the placebo effect: all we are talking about when we talk about the placebo effect is the change to perceptions.

The CAM (complementary and alternative medicine) schtick is to pretend that the substances and treatments being sold cause symptomatic changes through the placebo effect. There is no good evidence to back that up and much good evidence contrary to it. To be clear, the efficacy of CAM rests not in the treatments but in the beliefs of its patients.

In medicine, when a treatment performs no better than placebo, it means that treatment doesn’t work.

Got that? Placebo means it doesn’t work.

Believers and practitioners of CAM, however, forget – and often intentionally – that placebo treatments are physiologically inert and present them to patients as if they were real efficacious medicine. But they know it’s not. And yet we in the public continue to be inundated with messages that they do. Obviously, something here is out of whack, and it rests with the CAM crowd.

The underlying assumption associated with CAM products and treatments that the use of placebo causes no harm is just as risky as my pathetic little beer goggle analogy; one may think one is going home with a fox (of both genders, let me be clear) but wake up to a coyote ugly morning. The same is true with CAM: that patients are going home with a placebo but wake up to a nocebo ugly morning. By this I mean that promoting belief in placebo efficacy also means promoting belief in nocebo efficacy, which refers to harmful, unpleasant, or undesirable effects a subject can also manifest through perception.

The sum total of the medical efficacy complementary and alternative treatments and many nostrums pretends to have (with the exception of herbal substances that possess chemical properties that can interact with our biology in both positive and negative ways), rests not on the treatments themselves but on the double edged sword contained within the beliefs of its patients. Seeing the world through such faith-based beliefs is not an inherently good, positive, or even neutral perspective but an inherently dangerous one.

How so?

Well, the very real side effects of investing faith in such subjectively sensitive beliefs and acting on them as if they were true in reality can be life-altering when a negative drug interaction occurs because a patient forgets to tell a doctor about some CAM herbal nostrum, or postpones (like Steve Jobs) real medical intervention in favour of trying out some naturopathic treatment first, mistakenly hoping that wishful thinking through investing in faith-based belief will cause symptomatic changes, or that not vaccinating children will protect them from a perceived inoculation danger far smaller in reality than the very real and larger danger of an actual and highly contagious disease. These are some of the very real dangers faith-belief in CAM promotes. We need to take off our belief-based beer goggles before we do something stupid based on misunderstanding what placebo effect really means.

It’s not free… the irony is that most of the third world who has access to snake oil for a very low cost would do anything for western medicine that they can not afford to buy… and the people in the west who have relatively easy access to proper medicine are paying £80 for sugared pills and water…

The fact that there is a homeopathy business in western culture is clear evidence that there is a plague of stupidity ravaging its way through our society.

Sorry I commented late on this, MUR. I used the wrong spelling throughout (complImentary – meaning free – rather than complEmentary). I went back and edited but forgot to thank VA. She’s mentioned this same mistake I keep making before.

“Sorry I commented late on this, MUR. I used the wrong spelling throughout (complImentary – meaning free – rather than complEmentary). I went back and edited but forgot to thank VA. She’s mentioned this same mistake I keep making before.”

He he – I didn’t spot that either… but then my English is typically English… i.e. crap.

Here is an example of how the pharmaceutical industry uses placebos to measure effectiveness. If you are wondering what the relevance is to this post then it is quite simple. All drugs are compared against a placebo to test whether or not they improve a medical condition – if they do not perform better then they fail.

And since all alternative therapies perform no better than a placebo – then they have failed, and can not be called medicine.

Mainstream medicine tends to treat symptoms rather than address the underlying causes of diseases or conditions. Mainstream doctors generally have their dominant treatments, medicines and practices that relatively limit experimentation with individual patients. Alternative medicine tends to have more liberty to experiment and apply different treatments, and often experiment until they get results. In general, their treatments are typically very safe and often natural. (Alternative medicine practitioners often do and should earn income from their practices and products; but could it be that there is much more money in symptom management in the mainstream camps?),

Alternative medicine tends to have more liberty to experiment and apply different treatments… In general, their treatments are typically very safe and often natural.

Efficacious experiments? Efficacious treatments?

That’s laughable.

The hijacking and abuse of the medical term here – treatments – is not a coincidence but an intentional attempt to mislead and misguide the unwary into believing (without compelling evidence) that CAM is a legitimate and equivalent substitute for real medicine. It’s not. It’s a sham.

CAM lives only because this snake oil is generally unregulated…. and it’s unregulated because it’s non-efficacious!

Duh.

Its practitioners offer CAM as a pseudo-treatment with pseudo-experiments not to help the patient in any medical sense of the word (causing real effect by efficacious medical intervention) to address real problems with real medicine but because it is hugely profitable to appear to do something. And they can get away with this little charade pretending to be real health care professionals by doing little direct harm. That’s why CAM requires fooling people into thinking they are getting equivalent medical care when in fact they are not. At best, they are getting a sympathetic ear.

Now please note the typical sales job offered by Michael: real doctors dispensing real medicine through real treatments to cause effect on real symptoms are actually the profit-motivated snake oil salesmen trying to keep patients sick. Does this describe your doctor? Does this describe the symptom management AND ongoing attempts to get at the underlying causes your doctor does with you? Has your doctor suggested and recommended further testing and lab work to identify patterns and trends that can then be addressed? Or does you doctor set up a situation that has you coming back all the time for the same treatable problem like chiropractors do (and get away with because the ‘patient’ feels temporarily better)? CAM practitioners are consistently very good at one thing: vilifying efficacious treatments and those who carry them out while blaming everyone else to explain the lack of efficacy for their innocuous but expensive recurring placebos.

CAM and its practitioners today offer to patients what exorcisms once offered to those with mental health issues: the appearance of doing something for the good of the patient. And this is the Big Lie.

By definition, alternative medicine has either not being proved to work, or has been proved not to work… we therefore call alternative medicines that have been proven to work ‘medicine’.

As for harm and safety – ‘alternative’ treatments – that do not work cause horrendous amounts of harm – don’t believe me, then speak to the Apple computer founder Steve Jobs… opps oh no you can’t cause he’s dead!

Safer treatments, my arse – there is nothing safe about not being treated, and being conned into thinking that you are being treated by someone irresponsibly peddling the placebo effect.

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Questionable Motives is a site dedicated to raising important questions in the never-ending battle between rationality and superstition, offering commentary about topical issues, and addressing which of these motivations is truly being served.